Background: Non-AIDS defining malignancies, particularly colorectal cancer (CRC), may be more prevalent among persons living with HIV (PLWH). Further, PLWH may be less likely to receive CRC screening (CRCS). We studied the epidemiology of CRC and CRCS patterns in patients with and without HIV in a large Medicaid population.

Methods: We performed a matched cohort study examining CRC incidence in 2006 and CRCS between 1999 and 2007. Study participants were continuously enrolled in the Medicaid programs of California, Florida, New York, Ohio, and Pennsylvania. All HIV-infected enrollees were matched to five randomly sampled HIV-uninfected enrollees on five-year age group, sex, and state. Adjusted odds ratios (AORs) for incident CRC (adjusted for comorbidity index) and the presence of CRCS (adjusted for comorbidity index and years in the dataset) among PLWH compared to HIV-negative enrollees were calculated.

Results: PLWH were not more likely to be diagnosed with CRC after adjusting for comorbidity index (AOR 1.29; 95% CI: 0.98-1.70). While CRCS rates were low overall, PLWH were more likely to have received CRCS in unadjusted analyses (35.8% vs. 33.7%; OR 1.10, 95% CI: 1.07-1.13). This relationship reversed after adjusting for comorbidity index and years in the dataset (AOR: 0.80, 95% CI: 0.77-0.83).

Conclusion: PLWH were not more likely to be diagnosed with CRC. In adjusted analyses, PLWH were less likely to have received CRCS. We showed a low rate of CRCS overall. Work should be done to improve CRC screening rates for all Medicaid patients, particularly those with HIV.